The COA Club

In a program financed by the Commonwealth of Pennsylvania, called the Independent Drug Information Service, we scan the medical literature for the best evidence on how to treat a given medical problem (like high cholesterol or arthritis), boil it down into user-friendly packets of information, and then send nurses and pharmacists out to doctors’ offices to recommend optimal treatments. The information we provide is unbiased and noncommercial, and we don’t offer free trips to golf resorts. The resulting savings from more cost-effective prescribing could more than cover the costs of programs like this.

If Greg Mankiw can create a Pigou club for people who endorse taxes on carbon fuels, perhaps I can create a COA club for people who endorse ideas in Crisis of Abundance.

I agree that doctors as well as patients lack information about which procedures are most cost-effective. Of course, I would add some statistical and economic analysis into the mix of information that is provided.

Comments and Sharing

it's also about what's better: see buzzword "evidence-based medecine", as there is:
(a) too much tradition and too little science in the practice of medecine, and
(b) too little continuing training of doctors.

We may be dissatisfied with television for two quite different reasons: because the set does not work, or because we dislike the program we are receiving. Similarly, we may be dissatisfied with ourselves for two quite different reasons: because our body does not work (bodily illness), or because we dislike our conduct (mental illness). (Szasz 1990, p.127)

The difference between Szasz and most psychiatrists lies with the definition of bodily and mental illnesses. Szasz sees all mental illness as a matter of conduct (or moral judgements by psychiatrists). Most psychiatrists see many (but not all) mental illnesses as neurobiochemical problems that are just as much bodily illnesses as gout or hypothyroidism. Most psychiatrists do not see psychosis or schizophrenia or severe chronic depression as conduct choices made (knowingly or unknowingly) by patients. Szasz knows many well-defined bodily illnesses have psychiatric effects (depression with hypothyroidism, anxiety with pheochromocytoma, psychosis with COPD and hyperventilation, etc.) Yet, when such psychiatric illnesses appear without any obvious bodily cause, he labels them conduct. His illogic aggravates me.

Perhaps two new psychiatric diagnostic categories should be added:

1. Antipsychiatric personality disorder: persons who believe and vehemently argue that modern psychiatry is all wrong and use very selective examination of evidence to support that view.

2. Narcissistic personality disorder, behavioral economist variant: persons who believe against all logic and observation that all behavior has an economic basis.

I have to say that I find papers such as yours very strange. Not knowing the field, I cannot tell if it is a "gotcha" paper (a refereed journal published this bizarre discourse on economics and extreme preferences among crazy persons), a parody of what other economists have published, a way of blasting Szasz, or something else.

You know who doesn't lack information about which procedures are most cost-effective? Insurance companies.

They have data on millions of people, billions of procedures and tests, exact costs on all of those, sequence data on what order the tests were performed in, what the eventual and final diagnosis was on the basis of those tests, and what the life expectancy was for each person given a certain basket of prior conditions and proactive treatments.

If the government forced insurance companies to anonymize and publish all of this data for the Army of Davids to analyze, imagine what the data mining might find....

Imagine what a single knowledgeable data mining expert might find with that data in a single week...

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